Increasing vaccine uptake in Sudan: Development of a web-based intervention (Preprint)

BACKGROUND WHO described Vaccine hesitancy in 2019 as one of the top 10 threats to global health in high, and low, and middle-income countries. Various communication approaches have been used to engage the public about vaccines and immunization such as mass media and e-health strategies. With the expansion in the use of communication technologies in health in recent years, websites have increasingly been used to support vaccine acceptance and demand and thus increase vaccine uptake. We recently established a web-based intervention called the Tat3im initiative website in Sudan. It aims to increase uptake of vaccines in Sudan by increasing knowledge and addressing issues related to vaccine hesitancy and vaccine safety in the Arabic language OBJECTIVE This article describes the processes that we used to develop and improve this website including the creation of its content. METHODS These processes were informed by using and combining three sources including, Garrett’s user experience framework as a basis for the development, the WHO Vaccine Safety Net's (VSN) criteria for good information practices (i.e. credibility, content (quality and quantity), design and accessibility criteria), and previous relevant research that assessed the local context in Sudan. RESULTS We found that using such evidence as well as combining the VSN's criteria and previous research findings in the five planes of Garrett's framework enabled us to cover many essential elements of user experience and to address issues related to the website’s strategy and content. CONCLUSIONS As the website may be limited due to the high rates of illiteracy as well as relatively low internet use in Sudan, we suggest using social marketing to promote the use of the website as well as monitoring and evaluating the website and users’ experience using different approaches such as visitor traffic and qualitative measures.

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Attitudes toward the SARS-CoV-2 Vaccine: Results from the Saudi Residents’ Intention to Get Vaccinated against COVID-19 (SRIGVAC) Study

Vaccines ◽

10.3390/vaccines9070798 ◽

2021 ◽

Vol 9 (7) ◽

pp. 798

Author(s):

Sami H. Alzahrani ◽

Mukhtiar Baig ◽

Mohammed W. Alrabia ◽

Mohammed R. Algethami ◽

Meshari M. Alhamdan ◽

...

Keyword(s):

Saudi Arabia ◽

Health Beliefs ◽

Multinomial Logistic Regression ◽

Demographic Data ◽

Vaccine Uptake ◽

Vaccine Hesitancy ◽

Relative Risk Ratio ◽

Cross Sectional ◽

Vaccine Acceptance ◽

Web Based

Vaccine uptake could influence vaccination efforts to control the widespread COVID-19 pandemic; however, little is known about vaccine acceptance in Saudi Arabia. The present study aimed to assess the Saudi public’s intent to get vaccinated against COVID-19 and explore the associated demographic determinants of their intentions as well as the reasons for vaccine hesitancy. A cross-sectional, web-based survey was distributed to public individuals in Saudi Arabia between 25 December 2020 and 15 February 2021. Participants were asked if they were willing to get vaccinated, and the responses, along with demographic data were entered into a multinomial logistic regression model to assess the relative risk ratio (RRR) for responding “no” or “unsure” versus “yes”. Among 3048 participants (60.1% female, 89.5% Saudi), 52.9% intend to get vaccinated, 26.8% were unsure, and 20.3% refused vaccination. Vaccine hesitancy was significantly higher among females (RRR = 2.70, p < 0.0001) and those who had not been recently vaccinated for influenza (RRR = 2.63, p < 0.0001). The likelihood was lower among Saudis (RRR = 0.49, p < 0.0001), those with less than a secondary education (RRR = 0.16, p < 0.0001), perceived risks of COVID-19, and residents of the southern region (RRR = 0.46, p < 0.0001). The most often cited reasons for hesitancy were short clinical testing periods and concerns about adverse events or effectiveness. Vaccine hesitancy is mediated by many demographic factors and personal beliefs. To address vaccine-related concerns and amend deeply rooted health beliefs, communication should provide transparent information.

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COVID-19 vaccine brand hesitancy and other challenges to vaccination in the Philippines

PLOS Global Public Health ◽

10.1371/journal.pgph.0000165 ◽

2022 ◽

Vol 2 (1) ◽

pp. e0000165

Author(s):

Arianna Maever L. Amit ◽

Veincent Christian F. Pepito ◽

Lourdes Sumpaico-Tanchanco ◽

Manuel M. Dayrit

Keyword(s):

Ecological Model ◽

The Philippines ◽

Vaccine Uptake ◽

Phone Call ◽

Vulnerable Groups ◽

Vaccine Hesitancy ◽

Middle Income ◽

Political Issues ◽

Vaccination Uptake ◽

Vaccine Confidence

Effective and safe COVID-19 vaccines have been developed at a rapid and unprecedented pace to control the spread of the virus, and prevent hospitalisations and deaths. However, COVID-19 vaccine uptake is challenged by vaccine hesitancy and anti-vaccination sentiments, a global shortage of vaccine supply, and inequitable vaccine distribution especially among low- and middle-income countries including the Philippines. In this paper, we explored vaccination narratives and challenges experienced and observed by Filipinos during the early vaccination period. We interviewed 35 individuals from a subsample of 1,599 survey respondents 18 years and older in the Philippines. The interviews were conducted in Filipino, Cebuano, and/or English via online platforms such as Zoom or via phone call. All interviews were recorded, transcribed verbatim, translated, and analysed using inductive content analysis. To highlight the complex reasons for delaying and/or refusing COVID-19 vaccines, we embedded our findings within the social ecological model. Our analysis showed that individual perceptions play a major role in the decision to vaccinate. Such perceptions are shaped by exposure to (mis)information amplified by the media, the community, and the health system. Social networks may either positively or negatively impact vaccination uptake, depending on their views on vaccines. Political issues contribute to vaccine brand hesitancy, resulting in vaccination delays and refusals. Perceptions about the inefficiency and inflexibility of the system also create additional barriers to the vaccine rollout in the country, especially among vulnerable and marginalised groups. Recognising and addressing concerns at all levels are needed to improve COVID-19 vaccination uptake and reach. Strengthening health literacy is a critical tool to combat misinformation that undermines vaccine confidence. Vaccination systems must also consider the needs of marginalised and vulnerable groups to ensure their access to vaccines. In all these efforts to improve vaccine uptake, governments will need to engage with communities to ‘co-create’ solutions.

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The Behavioral Immune System and Vaccination Intentions During the Coronavirus Pandemic

10.31234/osf.io/r8uaz ◽

2021 ◽

Author(s):

Linda C. Karlsson ◽

Anna Soveri ◽

Stephan Lewandowsky ◽

Linnea Karlsson ◽

Hasse Karlsson ◽

...

Keyword(s):

Immune System ◽

Psychological Adaptation ◽

Vaccine Safety ◽

Vaccine Uptake ◽

Vaccine Hesitancy ◽

System Response ◽

Risk Of Infection ◽

Behavioral Immune System ◽

Immune System Response ◽

The Relationship

The behavioral immune system is considered to be a psychological adaptation that decreases the risk of infection. Research suggests that, in the current environment, this system can produce attitudes with negative health consequences, such as increased vaccine hesitancy. In three studies, we investigated whether two facets of the behavioral immune system—contamination aversion (i.e., avoiding potential contamination) and perceived infectability (i.e., perceived susceptibility to disease)—predicted intentions to accept COVID-19, influenza, and measles or general childhood vaccinations. Both contamination aversion and perceived infectability were higher during than before the pandemic. In contrast to previous research, those with higher contamination aversion during the pandemic perceived vaccines to be safer and had higher intentions to accept vaccination. Contamination aversion before the pandemic was not associated with perceived vaccine safety or vaccination intentions during the pandemic. Individuals who perceived themselves as more susceptible to diseases were slightly more willing to accept vaccination. We conjecture that high disease threat reverses the relationship between the behavioral immune system response and vaccination. As the associations were weak, individual differences in contamination aversion and perceived infectability are of little practical relevance for vaccine uptake.

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Willingness, beliefs, and barriers regarding the COVID-19 vaccine in Saudi Arabia: a multiregional cross-sectional study

BMC Family Practice ◽

10.1186/s12875-021-01606-6 ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Noura Altulahi ◽

Shouq AlNujaim ◽

Azzam Alabdulqader ◽

Abdullah Alkharashi ◽

Assaf AlMalki ◽

...

Keyword(s):

Saudi Arabia ◽

Herd Immunity ◽

Vaccine Safety ◽

Cross Sectional Study ◽

Vaccine Uptake ◽

Vaccine Hesitancy ◽

Considerable Proportion ◽

Cross Sectional ◽

High School Degree ◽

Validated Questionnaire

Abstract Background The coronavirus disease 2019 (COVID-19) has spread worldwide, and the vaccine remains the ultimate cornerstone to overcoming its long-term impact. Vaccine hesitancy might obstruct the effort to achieve herd immunity and eradicate the virus. We assessed Saudi Arabian individuals’ willingness, beliefs, and barriers regarding the COVID-19 vaccine and their adherence to preventive measures during and after the pandemic. Methods A self-administered electronic validated questionnaire was distributed among the five major regions in Saudi Arabia between November and December 2020. The questionnaire addressed the sociodemographic data, beliefs, potential barriers, parents’ acceptance of COVID-19 vaccination for their children, and adherence to protective measures during and after the pandemic. Results Of 8,056 participants, 4,218 (52.4%) of a non-representative sample were willing to be vaccinated against COVID-19. Being a young adult, male, having less than a high school degree, being a smoker, having a chronic disease, and having a history of seasonal influenza vaccine uptake were positive predictors of COVID-19 vaccine acceptance. Hesitant participants reported concerns about vaccine side effects and safety as the main barriers to accepting the COVID-19 vaccine. Some refusers (26.1%) declared that they would reconsider vaccination only if the safety and effectiveness of the vaccine were reported by more studies. Conclusions Our study revealed a promising willingness to accept the vaccine among the population, with positive beliefs and attitudes toward COVID-19 vaccination. However, a considerable proportion of the population was reluctant to accept the vaccine. Thus, publicly providing information about vaccine safety and implementing health education programs is crucial for increasing the public’s confidence in the vaccine.

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Multilevel Determinants of COVID-19 Vaccine Uptake Among South Asian Ethnic Minorities in Hong Kong: Cross-sectional Web-Based Survey (Preprint)

10.2196/preprints.31707 ◽

2021 ◽

Author(s):

Akansha Singh ◽

Angel Hor Yan Lai ◽

Jingxuan Wang ◽

Saba Asim ◽

Paul Shing-Fong Chan ◽

...

Keyword(s):

Hong Kong ◽

Ethnic Minorities ◽

South Asian ◽

South Asians ◽

Vaccine Uptake ◽

Vaccine Hesitancy ◽

Cross Sectional ◽

Web Based ◽

Individual Level ◽

Religious Reasons

BACKGROUND The COVID-19 pandemic continues to have a disproportionate effect on ethnic minorities. Across countries, greater vaccine hesitancy has been observed among ethnic minorities. After excluding foreign domestic helpers, South Asians make up the largest proportion of ethnic minorities in Hong Kong. It is necessary to plan for COVID-19 vaccination promotional strategies that cater to the unique needs of South Asians in Hong Kong. OBJECTIVE This study investigated the prevalence of COVID-19 vaccine uptake among a sample of South Asians in Hong Kong. We examined the effects of sociodemographic data and factors at individual level (perceptions), interpersonal level (information exposure on social media), and sociostructural level (cultural) based on the socioecological model. METHODS A cross-sectional web-based survey was conducted on May 1-31, 2021. Participants were South Asian people aged 18 years or older living in Hong Kong; able to comprehend English, Hindi, Nepali, or Urdu; and having access to a smartphone. Three community-based organizations providing services to South Asians in Hong Kong facilitated the data collection. The staff of the community-based organizations posted the study information in WhatsApp groups involving South Asian clients and invited them to participate in a web-based survey. Logistic regression models were fit for data analysis. RESULTS Among 245 participants, 81 (33.1%) had taken at least one dose of the COVID-19 vaccine (one dose, 62/245, 25.2%; and both doses, 19/245, 7.9%). After adjusting for significant background characteristics, cultural and religious reasons for COVID-19 vaccine hesitancy were associated with lower COVID-19 vaccine uptake (adjusted odds ratio [AOR] 0.83, 95% CI 0.71-0.97; P=.02). At the individual level, having more positive attitudes toward COVID-19 vaccination (AOR 1.31, 95% CI 1.10-1.55; P=.002), perceived support from significant others (AOR 1.29, 95% CI 1.03-1.60; P=.03), and perceived higher behavioral control to receive COVID-19 vaccination (AOR 2.63, 95% CI 1.65-4.19; P<.001) were associated with higher COVID-19 vaccine uptake, while a negative association was found between negative attitudes and the dependent variable (AOR 0.73, 95% CI 0.62-0.85; P<.001). Knowing more peers who had taken the COVID-19 vaccine was also associated with higher uptake (AOR 1.39, 95% CI 1.11-1.74; P=.01). At the interpersonal level, higher exposure to information about deaths and other serious conditions caused by COVID-19 vaccination was associated with lower uptake (AOR 0.54, 95% CI 0.33-0.86; P=.01). CONCLUSIONS In this study, one-third (81/245) of our participants received at least one dose of the COVID-19 vaccine. Cultural or religious reasons, perceptions, information exposure on social media, and influence of peers were found to be the determinants of COVID-19 vaccine uptake among South Asians. Future programs should engage community groups, champions, and faith leaders, and develop culturally competent interventions.

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Vaccine hesitancy among healthcare providers during COVID-19 pandemic

European Journal of Public Health ◽

10.1093/eurpub/ckab164.101 ◽

2021 ◽

Vol 31 (Supplement_3) ◽

Author(s):

F Algabbani ◽

A Algabbani

Keyword(s):

Healthcare Providers ◽

Vaccine Safety ◽

Vaccine Hesitancy ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Vaccine Acceptance ◽

Web Based ◽

Global Health Issue ◽

Vaccine Confidence ◽

And Control

Abstract Public trust in vaccines is a major global health issue. This study aims to assess the vaccine acceptance among healthcare workers and their confidence and hesitancy of the COVID19 vaccine. This was a multicenter cross-sectional survey conducted among healthcare providers in Riyadh, the capital of Saudi Arabia. Data collection was carried out between October and November of 2020 through a web-based survey. COVID19 vaccine hesitancy was assessed using eight structured items adapted from the 5Cs. About 34.6% (95% CI: 27.6%-42.4%) of participants were willing to vaccinate against COVID-19 and 44% (95% CI: 36.5%-51.9%) will recommend the vaccine to their patients. About 45% of participants were neutral regarding vaccine safety and 40% were neutral regarding vaccine effectiveness. Almost 70% believe that the duration of clinical studies of the COVID-19 vaccines affects their confidence in the efficacy and safety of the vaccine. Those who never hesitated or delayed taking any of the recommended vaccination were more likely to be willing to vaccinate COVID-19 (OR 5.46, 95% CI: 2.49-11.98). Assessing the level of vaccine confidence in the population and associated factors will help implement an effective national vaccine program to enhance vaccination uptake and control COVID19 spread during this pandemic. Key messages Vaccine hesitancy is challenging vaccination goals at the national and global level. Hesitancy from the population toward vaccine and concerns regarding its safety and efficacy was observed with the development of a novel vaccine for COVID19 a newly emerged infection.

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Exploring the role and nature of trust in institutional capacity building in low- and middle-income countries: a systematic review

10.21203/rs.3.rs-131727/v1 ◽

2020 ◽

Author(s):

Malvikha Manoj ◽

Richard Brough ◽

Anna Kalbarczyk

Keyword(s):

Systematic Review ◽

Capacity Building ◽

Full Text ◽

Essential Elements ◽

Institutional Capacity ◽

Local Context ◽

Institutional Trust ◽

Middle Income ◽

Middle Income Countries ◽

Health Institutions

Abstract Background Global concern with strengthening institutions is evident and has been underscored in the wake of the COVID-19 pandemic. Trusted or trustworthy institutions are vital in addressing institutional capacity strengthening, but there is limited research on institutional trust and how to build it. A preliminary approach entitled, Trusted Institutions (TI), identifies six essential elements of trust including: team culture, autonomy, scale and longevity, commitment to quality and ethics, sustainability, and good fit with local context and culture. We aimed to explore capacity building initiatives and the notion of ‘trust’ within non-government health institutions in low- and middle-income countries (LMICs) and validate these essential elements of trust through a systematic review.Methods We searched the published literature in PubMed and EMBASE in March 2020 and employed a three-concept search that included “health-related institutions”; “capacity building”; and “LMICs”. The study team used PRISMA reporting guidelines to conduct title and full-text reviews and conduct data extraction and analysis.Results The search yielded 342 unique articles. Seventy-seven references met initial inclusion criteria and underwent full-text extraction; 31 studies were included in the final analysis. Capacity building activities ranged from individual-level skills to institutional systems and structures. All articles addressed at least one element of trust with over half of articles describing sustainability (n = 18; 58%) and good fit with local context and culture (n = 18; 58%). Only 14 (45%) of articles explicitly mentioned the concept of trust either within an institution (intra-institutional) or between two or more institutions (interinstitutional). Four additional themes emerged as relevant to institutional trust including collaboration, communication, extent of institutional networks, and intersectionality.Conclusions This review validates essential elements of trust in the TI approach and documents the importance of building trust both within and between institutions. The TI approach can be used by public health institutions in LMICs to enhance their abilities to achieve institutional missions and meet global targets.

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Beliefs associated with Intentions of Non-Physician Healthcare Workers to Receive the COVID-19 Vaccine in Ontario, Canada

10.1101/2021.02.19.21251936 ◽

2021 ◽

Author(s):

Laura Desveaux ◽

Rachel Savage ◽

Mina Tadrous ◽

Natasha Kithulegoda ◽

Kelly Thai ◽

...

Keyword(s):

Herd Immunity ◽

Theoretical Domains Framework ◽

Good Health ◽

Vaccine Safety ◽

Vaccine Uptake ◽

Web Based ◽

Post Vaccination ◽

Safety Concerns ◽

Ethnic Subgroups ◽

To Receive

Achieving herd immunity of SARS-CoV-2 through vaccines will require a concerted effort to understand and address barriers to vaccine uptake. We conducted a web-based survey of non-physician HCWs, informed by the Theoretical Domains Framework, measuring intention to vaccinate, beliefs and sources of influence relating to the COVID-19 vaccines, and sociodemographic characteristics. Vaccination non-intent was associated with beliefs that vaccination was not required because of good health, lower confidence that the COVID-19 vaccine would protect their family and patients, and that getting vaccinated was a professional responsibility. Vaccination non-intent was strongly associated with mistrust about how fast the vaccines were developed and vaccine safety concerns. Communication directed at non-physician HCWs should be tailored by ethnic subgroups and settings to increase salience. Messaging should leverage emotions (e.g., pride, hope, fear) to capture interest, while addressing safety concerns and confirming the low risk of side effects in contrast to the substantial morbidity and mortality of COVID-19. Emergent data about reduced transmission post-vaccination will be helpful.

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COVID-19 Vaccine Perceptions and Differences by Sex, Age, and Education in 1,367 Community Adults in Ontario

Frontiers in Public Health ◽

10.3389/fpubh.2021.719665 ◽

2021 ◽

Vol 9 ◽

Author(s):

Sabrina K. Syan ◽

Mahmood R. Gohari ◽

Emily E. Levitt ◽

Kyla Belisario ◽

Jessica Gillard ◽

...

Keyword(s):

Side Effects ◽

Vaccine Safety ◽

Bachelor's Degree ◽

Vaccine Uptake ◽

Vaccine Hesitancy ◽

Online Assessment ◽

Cross Sectional ◽

Global Pandemic ◽

To Receive

Background: COVID-19 is a global pandemic and vaccination efforts may be impeded by vaccine hesitancy. The present study examined willingness to receive a COVID-19 vaccine, the associated reasons for willingness/unwillingness, and vaccine safety perceptions in a cross-sectional assessment of community adults in Ontario.Methods: One thousand three hundred sixty seven individuals (60.6% female, mean age = 37.5%) participated in this study between January 15, 2021 and February 15, 2021. Perceptions of vaccine safety and reasons for willingness/unwillingness to receive the COVID-19 vaccine were investigated using an online assessment. Perceptions were investigated in general and by age, sex and education using analysis of variance.Results: Overall, 82.8% of the sample reported they were willing to receive a COVID-19 vaccine and 17.2% reported they were unwilling. The three most common reasons for unwillingness were long-term side effects (65.5%), immediate side effects (60.5%), and lack of trust in the vaccine (55.2%). Vaccine willingness significantly differed by sex and education level, with female participants and those with less than a bachelor's degree being more likely to report unwillingness. Perception of COVID-19 vaccine safety was significantly lower (−10.3%) than vaccines in general and differed by age, sex and education, with females, older adults, and individuals with less than a bachelor's degree reporting lower perceived COVID-19 vaccine safety.Conclusion: In this sample of community adults, the COVID-19 vaccine hesitancy rate was less than one in five individuals, but with higher rates in population subgroups. Targeting public health messaging to females and individuals with less than bachelor's degree, and addressing concerns about long-term and immediate side effects may increase vaccine uptake.

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COVID-19 Vaccine Concerns about Safety, Effectiveness, and Policies in the United States, Canada, Sweden, and Italy among Unvaccinated Individuals

Vaccines ◽

10.3390/vaccines9101138 ◽

2021 ◽

Vol 9 (10) ◽

pp. 1138

Author(s):

Rachael Piltch-Loeb ◽

Nigel Walsh Harriman ◽

Julia Healey ◽

Marco Bonetti ◽

Veronica Toffolutti ◽

...

Keyword(s):

United States ◽

Population Control ◽

Vaccine Safety ◽

The United States ◽

Vaccine Effectiveness ◽

Vaccine Uptake ◽

Vaccine Hesitancy ◽

Government Control ◽

Thematic Area ◽

Safety Effectiveness

Despite the effectiveness of the COVID-19 vaccine, global vaccination distribution efforts have thus far had varying levels of success. Vaccine hesitancy remains a threat to vaccine uptake. This study has four objectives: (1) describe and compare vaccine hesitancy proportions by country; (2) categorize vaccine-related concerns; (3) rank vaccine-related concerns; and (4) compare vaccine-related concerns by country and hesitancy status in four countries—the United States, Canada, Sweden, and Italy. Using the Pollfish survey platform, we sampled 1000 respondents in Canada, Sweden, and Italy and 750 respondents in the United States between 21–28 May 2021. Results showed vaccine-related concerns varied across three topical areas—vaccine safety and government control, vaccine effectiveness and population control, and freedom. For each thematic area, the top concern was statistically significantly different in each country and among the hesitant and non-hesitant subsamples within each county. Concerns related to freedom were the most universal. Understanding the specific concerns among individuals when it comes to the COVID-19 vaccine can help to inform public communications and identify which, if any, salient narratives are global.

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